Why does footwear fit matter with an orthosis?
The shoe and orthosis work together as a system. If the shoe is too small, it can compress the device or create pressure. If it is too large, the foot and orthosis may move excessively.
What should you fit first?
The orthosis should be correctly positioned on the foot before the shoe is fitted over it.
Fasten the orthosis as instructed, then insert the foot-and-orthosis unit into the shoe.
How much width is needed?
The shoe needs enough width for the orthosis at its broadest points, not just for the bare foot.
The sides of the shoe should not visibly bow out because the device is being forced into a narrow last.
Why is depth important?
An AFO or SMO can lift the foot higher inside the shoe. Insufficient depth may cause pressure over the toes, instep or rear foot.
A removable insole can sometimes create more space where the shoe is designed for this.
How should the heel sit?
The heel should remain as far back and as stable as the combined orthosis-and-shoe design allows.
If the orthosis pushes the heel forwards or the heel repeatedly lifts out of the shoe, fit should be reassessed.
How should the shoe fasten?
The fastening should close securely without being stretched to its limit.
A wide-opening upper can make it easier to insert the orthosis before fastening the shoe around it.
What about toe room?
The toes should not be pressed against the end or upper of the shoe.
Check toe room with the orthosis in place because the device can change the position of the foot within the shoe.
Important: Do not trim, bend or heat-adjust a prescribed AFO or SMO to make it fit a shoe unless this is carried out or specifically advised by the responsible orthotic service.
Should you buy a much bigger shoe?
Not automatically. Oversizing in length can reduce control and cause the foot to slide.
A shoe designed with extra depth, width and opening is generally preferable to gaining space only by increasing length.
What should be checked after walking?
- skin pressure or persistent redness;
- the orthosis remaining correctly positioned;
- heel slippage;
- toe pressure;
- shoe distortion;
- fastenings remaining secure.
How often should fit be reviewed?
Review whenever the orthosis is changed, the wearer grows, swelling changes or new pressure appears.
For children, regular checks are especially important because growth can make a previously suitable shoe too small.
When should professional advice be sought?
Seek orthotic or clinical advice if the footwear appears to alter orthosis function, fit cannot be achieved without pressure, or walking becomes less stable after changing shoes.
